Cardiovascular EM Quiz

A 65-year-old male with a history of atrial fibrillation, congestive heart failure, and hypertension is brought in by ambulance after being found by his wife in the bathroom unconscious. She heard something fall and found him laying on the ground unresponsive. Initial vital signs demonstrate BP 224/121, P 76, RR 16, O2sat 94% room air. He is protecting his airway, but is disoriented and not following commands. An image from his noncontrast head CT is shown. Which of the following is the best medication for the management of his blood pressure?

A 55-year old male with a history of recently diagnosed and untreated small cell lung cancer presents with acute on chronic shortness of breath for 1-2 hours. He is speaking 4-5 word sentences and is diaphoretic. BP 78/45, P 121, RR 29, T99.0F (37.2C), O2Sat 99% room air. Lung auscultation demonstrates minimal bibasilar crackles, and cardiac auscultation reveals muffled heart sounds. The patient demonstrates 6cm jugular venous distention. ECG is shown. Which of the following is the most appropriate initial step in management of this patient?

A 77-year-old female is brought in by ambulance for a syncopal episode today in the kitchen, witnessed by her daughter. Her past medical history includes hypertension and recently diagnosed pneumonia. She takes hydrochlorothiazide regularly and is almost finished with her levofloxacin. Vital signs are BP 131/78 mmHg, P 72 bpm, RR 16 bpm, O2sat 98% room air, T98.4F (36.9C). The patient reports feeling palpitations and lightheadedness immediately before losing consciousness. Currently, the patient denies chest pain, fever, shortness of breath, vomiting or abdominal pain. ECG is shown. What should be the next step in management of this patient?

A 55-year-old female with hypertension presents with sudden onset tearing chest pain radiating to her upper back. Vital signs are: BP 151/89, P 99, RR 18, O2Sat 99% room air, T 98.5F (36.9C). Physical exam reveals diminished bilateral femoral pulses. An image of the computed tomography angiography of the chest is shown. Morphine has resolved her pain. Labetalol is ordered and pending. What is the next best step in the management of this patient?

A 65-year-male is brought in by ambulance for severe abdominal pain causing near syncope. The pain began one hour ago in his abdomen and radiates to the flank. He has associated nausea, vomiting and lightheadedness. Past medical history is significant for hypercholesterolemia, hypertension and tobacco. Vital signs are: BP 89/65, P 97, RR 22, T99.0F (37.2C), O2Sat 100% room air. Your bedside ultrasound of the abdominal aorta is shown below. What is the next best step in the management of this patient?

A 17-year-old male is brought to the ED after losing consciousness at football practice. He denies any preceding symptoms and has a normal physical examination. An ECG is obtained as shown. Based on these findings, which of the following is the most likely diagnosis?

A 45-year old male presents to the Emergency Department with acute onset chest pain and shortness of breath less than 1 hour ago while mowing his lawn. Initial EKG is shown below. Which coronary artery is most likely to be occluded?